| NPI | 1568719425 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME128949) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL 34976) |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2021-12-08 |